1102 Initial Triage Location in Moderate Traumatic Brain Injury: A Comparison of Direct Level 1 Trauma Center Admission Versus Transfer From Regional Centers

INTRODUCTION: The Brain Trauma Foundation's 2023 guidelines highlight the need to determine optimal post-traumatic destination for patients with moderate traumatic brain injury (mTBI) defined as a field Glasgow Coma Scale (GCS) Score of 9-12. We investigated outcomes between direct Level 1 trauma center admission versus initial triage to regional centers with subsequent transfer. METHODS: A retrospective cohort study of 179 consecutive adult (≥18) with mTBI from 2019-2023. Patients were dichotomized into regional triage and subsequent transfer to Level 1 Trauma Centers (n = 53) verses direct Level-1 Trauma Center admissions (n = 126). Primary outcomes included in-hospital mortality, discharge disposition, and Glasgow Outcome Scale Extended (GOSE) scores at six months. Groups were compared for similarity using initial GCS, rates of polytrauma, and intracranial injury severity as measured by rates of mulit-compartment hemorrhage (Rotterdam 4+). Epi for R was used for statistical analysis. RESULTS: Initial presentation was similar between groups including GCS (transfer: 11.17 vs. direct: 11.12, p = 0.61), rates of polytrauma (transfer: 14/53 vs. direct: 32/126, p = 1.0), and multicompartment hemorrhage (transfer: 19/53 vs. direct: 46/126, p = 1.0). No significant differences were found in in- hospital mortality (transfer: 10/53 vs. direct: 22/126, p = 0.84), discharge to home/skilled nursing facility (transfer: 29/53 vs. direct: 72/126, p = 0.89), or in-patient rehabilitation (transfer: 13/53 vs. direct: 20/126, p = 0.25). GOSE scores at six months were comparable for surviving patients with active follow-up (transfer: n = 32, 4.72 vs. direct: n = 80, 5.51, p = 0.27). CONCLUSIONS: In this mTBI cohort, patients demonstrated similar outcomes regardless of initial triage location. These findings may suggest that mTBI patients can be safely evaluated at the closest regional centers before potential transfer, particularly when considering the emergent nature of TBI. These findings may help optimize resource utilization within regional trauma networks.